A holistic approach to health and care


Jeremy Corbyn has made clear that health will be a priority under his leadership, specifically ending the internal market and privatisation of the NHS. More broadly he has written of “a more holistic approach to health, and addressing the grotesque health inequalities existing in modern Britain”.

The challenge for the new Shadow Secretary of State for Health will be to turn this approach into a coherent picture of the future of health and care. Jeremy is absolutely right about the importance of fighting NHS privatisation and tackling health inequalities. But we also need to put forward positive policies about what a socialist model of health and care should look like.

On the issue of a holistic approach, one thing that must change is the ‘Cinderella’ status of mental health.  Jeremy has signalled a change of status by appointing a new Cabinet-level minister for mental health. A holistic approach should also mean an approach which looks at people’s health and personal care needs as a whole. And until personal care is provided on the same basis as health care, there will not be parity between mental and physical health. For example, why do people with dementia have to pay for their care (it is counted as social care) when people with cancer do not (it is counted as health care)? We have a very serious crisis of social care in this country right now and the Government has done much to make it worse. Former Liberal Democrat Care Minister, Norman Lamb has warned that care services are on the brink of collapse and said that, “elderly people won’t get the care they need, and it will be people with mental ill health who suffer most, because that is where the squeeze always comes”.

  • Local Government has been cut to the bone and at the same time has been given extra responsibilities for both public health and social care.
  • There aren’t enough people in the care workforce to provide the care needed
  • The increase in the minimum wage (which the Tories have disgracefully rebranded as a ‘living wage’) and the recent EU ruling on payment for travel to work, could, in theory improve the conditions of care workers and perhaps attract more much-needed numbers into the workforce, but local authorities don’t have enough funding to pay care providers.
  • Care providers are already going out of business (two companies in my mother’s county have recently closed down, leaving only one non-profit organisation to provide home care – this has meant clients’ hours being restricted and changed and, frequently, no carer available at all). The United Kingdom Home Care Association  has said that many of the biggest providers were considering handing back as much as half of their local authority business. This is likely to lead to a situation in which self-funders are paying for a reasonable quality of care, while those currently entitled to free care get a poor and rushed ‘sink’ service. One of the many dangers in this situation is that self-funders (a majority of whom are currently Tory voters) will judge that they have nothing invested to their own benefit in the public care system. This presents a dangerous template for the future of the NHS.
  • There is huge, intolerable pressure on informal, unpaid carers, including older carers whose numbers have risen to nearly 1.5 million.
  • Funding cuts have also affected voluntary sector organisations, making them, in turn, less able to offer support to those who need long-term care and their carers.

We really need to get rid of the artificial divide between ‘health care’ and ‘personal care’ for a huge number of reasons.  I would welcome a discussion in SHA about whether we shouldn’t be the Socialist Health and Care Association. It’s good that there is a new Labour Social Work Group with an eminent chair, but it would be even better if there was just one organisation developing policy on health and care together. People who are passionate about the NHS often, for very understandable reasons, forget to think about social care and what the lack of it can do to worsen people’s health, including the health of the increasing numbers who provide unpaid care, and thereby put additional pressure on the NHS. But if we don’t give a high priority to enabling social care services to prevent people from developing health crises and intervening at an early stage, we will not end up with a health and care service that contributes to reducing health inequalities and improving people’s general wellbeing. I think Andy Burnham acknowledged this in his proposal for a national care service that would be closely linked if not merged with the NHS. Of course there are all sorts of issues (eg about how to maintain local accountability) which arise from this, but we have to address these in the NHS and we could do the same with a national care service.

I’ve never understood why the Labour Party didn’t pounce on and use the proposals made by the Barker Commission on the funding of health and social care, published last year. It was commissioned by the King’s Fund and chaired by a former member of the Bank of England Monetary Policy Committee. It concluded that social care (above a certain level of need, but that is open to debate) should be free and funded from taxation and national insurance AND that the country could afford it. These Commissioners were by no means wild-eyed radicals and the report presented comparisons with the proportion of GDP spent on health and care in comparable countries to back up the recommendations showing how the funding could be raised. We might not agree with all the proposals, but by and large they are consistent with SHA policy. It is a brilliant source of evidence and argument in favour of free social care.

Unless this Government does a gigantic U-turn, by the time of the next election it will be presiding over two-tier services with the remnants of free social care – and therefore the people most in need – at the bottom of the heap. We urgently need to develop a coherent vision of what a properly funded, resourced, staffed and free health and care service could look like and the benefits it could bring to the whole country, not just to users of services.